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General NPI Number Information
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NPI Number | 1710670690
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Entity Type | Individual
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Provider Name | JARED JONES PTA
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Gender | Male
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Dates
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Enumeration Date | 05/29/2023
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Last Update Date | 05/29/2023
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Provider Practice Location Address
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Address Line | 930 COLFAX DR
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City | DANVILLE
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State | IL
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Zip | 61832-3325
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Country | US
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Telephone | 217-264-0348
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Fax |
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Provider Business Mailing Address
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Address Line | 15424 US HIGHWAY 150
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City | PARIS
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State | IL
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Zip | 61944-6604
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Country | US
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Telephone | 217-264-0348
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State | IL
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